The Donation of Bodies to Medical Schools

(YD 349:1-2; 357:1)

Question:
Is it permissible for a person to donate his body to a medical school and, if so, under what conditions? If a person did so, is it permissible to bury him in a Jewish cemetery after the donation period is over? When does one mourn for such a person?

Responsum:
Donating a body to a medical school is permitted under the conditions described below. There is general agreement that autopsies are essential in order to learn pathology or to learn the cause of death where unknown. There is not complete agreement, however, regarding whether autopsies are essential in order to learn anatomy, but most doctors still feel that there is no substitute to working with cadavers. If technology comes up with a cheap, accurate, simulation substitute, then there will be room to reevaluate this subject.

The main question is what is the attitude of the halakhah to maintaining a first-rate medical system in a Jewish state. Most of the poskim until today have preferred to deal with the specific issues involved without dealing with their implications for maintaining an advanced medical system in a Jewish state. That is why some rabbis have ruled that Israeli medical students should learn medicine on non-Jewish cadavers imported from abroad. But this contradicts a basic Jewish value that all human beings were created in God's image. We should not learn medicine at the expense of people of other faiths. Halakhic rulings based on such a distinction suffer, in our opinion, from an ethical flaw and should not serve as a precedent in an independent Jewish state.

Another problem is that most of the poskim have dealt with autopsies performed for the purpose of discovering the cause of death without relating to the fact that most medical students learn anatomy by dissecting the bodies of people who died of natural causes.

As for the first question posed above, many rabbis are opposed to such autopsies because it is forbidden to derive benefit from the dead (Avodah Zarah 29b). But other rabbis have maintained that examining a body and feeling the organs in order to learn anatomy or pathology are not considered deriving benefit from the dead. Others are opposed because of the prohibition of delaying burial and because of the obligation to bury the dead (Deuteronomy 21:22-23; Mishnah Sanhedrin 6:5; Yerushalmi Nazir 7:1). However, the fact of the matter is that both the hospitals and the law require that all organs must be buried at the end of the period of donation. The only problem pertains to the blood of the deceased, which is removed by the medical school immediately after death and is usually not saved for burial. But Rabbi Eliezer Waldenberg has shown that there is no obligation to bury blood that left the body after death.

Another problem is that a person may not forgo his own burial. But that, too, is not really relevant to our case because those who donate their bodies only forgo their immediate burial, not their burial, and they do so in order to perform the mitzvah of helping to save the lives of others.

Thus there is no transgression of these two principles as long as the entire body is buried at the end of the period of donation. Another fear is that of "nivul hamet" or desecrating the dead. Some consider this an insult to the dead, others to his family, while others link it to the verse "you shall love your neighbor as yourself". The question is whether the autopsy in question is automatically considered "nivul hamet" even if done respectfully, or whether this prohibition can be set aside by other considerations. R. Jacob Ettlinger takes the stringent view, while Maharam Schick says that "nivul hamet" is set aside even if there is a chance of saving a life.

Those who forbid autopsies performed by medical students say that pikuah nefesh only applies when the sick person is "in front of us", following the classic responsum of Rabbi Yehezkel Landau. But Rabbis Eliezer Berkovits and Immanuel Jakobovits have already pointed out that, given modern methods of communication and the large number of medical journals, every patient in the world is "in front of us". In any case, even if one can argue whether all patients are "in front of us", all the patients in the State of Israel are our responsibility and we must take into account pikuah nefesh of the entire community and not just of individuals.

It is clear from all of the above that donating a body to a medical school is permitted for a fixed period such as a year, providing the autopsy is performed with respect and that all parts of the body will be buried at the end of the designated period. We suggest that medical students recite a special prayer before each class or session to give the class a spiritual dimension (see the Appendix). The hands should also be washed without a blessing after the procedure just as they are washed upon leaving a cemetery.

In light of the above, it is clear that the body should be buried in a Jewish cemetery at the end of the designated period.

As for when to mourn, one rabbi says that the relatives are onenim until the body is buried while another says they observe aveilut only after the burial. These approaches are psychologically untenable. A person cannot be an onen for a year or observe aveilut a year after a relative dies. Rather, we should follow the model of a person who is sent for burial in another city and we don't know when he will be buried (Yoreh Deah 375:2). The period of aveilut begins from the minute the body is taken away. So in our case the period of aninut will be from the time of death until the body is turned over to the medical school, and the period of aveilut will begin when the body is turned over to the medical school. The obligation to bury the body lies with the family, though they may rely on the medical school as prescribed by Israeli law. Even so, it is preferable that the family should participate in the burial. On that day, the family should observe one day of mourning, as was practiced on the day of gathering the bones of the deceased for reburial in the Talmudic period (Yoreh Deah 403:1).